Modified soluble vegf receptor-1 genes and vectors for gene therapy

ABSTRACT

The present invention relates to a modified and optimized sFlt1 nucleic acid for inclusion in a virus vector. Use of such vectors can be used for treatment of ocular disorders causing neovascularization, such as macular degeneration.

CROSS REFERENCE TO RELATED APPLICATION

The present application claims priority to U.S. Provisional Patent Application No. 61/782,450 filed on Mar. 14, 2013 the contents of which are hereby incorporated by reference herein for all purposes.

BACKGROUND OF THE INVENTION Field of the Invention

The invention relates to modified soluble VEGF receptor-1 (also known as sFlt1) genes, nucleic acid vectors including the modified genes, optimized viral capsids including the modified genes, methods of using the modified genes in the treatment of diseases related to ocular neovascularization, such as macular degeneration.

Discussion of Related Art

Leading causes of severe vision loss and blindness are ocular-related disorders wherein the vasculature of the eye is damaged or insufficiently regulated. Ocular-related diseases comprising a neovascularization aspect are many and include, for example, exudative age-related macular degeneration, diabetic retinopathy, corneal neovascularization, choroidal neovascularization, neovascular glaucoma, cyclitis, Hippel-Lindau Disease, retinopathy of prematurity, pterygium, histoplasmosis, iris neovascularization, macular edema, glaucoma-associated neovascularization, and the like.

Damage of the retina, i.e., retinal detachment, retinal tears, or retinal degeneration, is directly connected to vision loss. A common cause of retinal detachment, retinal tears, and retinal degeneration is abnormal, that being, uncontrolled vascularization of various ocular tissues.

It has been found that vascular endothelial growth factor (VEGF) is a major stimulatory factor for retinal neovascularisation. It is unlikely to be the only stimulatory factor but it is nevertheless the key factor involved. VEGF is upregulated by hypoxia and its levels are increased in the retina and vitreous of patients or laboratory animals with ischaemic retinopathies. Also, increased expression of VEGF in retinal photoreceptors stimulates neovascularisation in the retina and VEGF antagonists inhibit retinal or iris neovascularisation in animal models.

For many ocular-related disorders, no efficient therapeutic options currently are available. Laser photocoagulation involves administering laser burns to various areas of the eye and is used in the treatment of many neovascularization-linked disorders. Laser treatment does not guarantee that vision loss will be attenuated. In fact, many patients afflicted with age-related macular degeneration eventually experience severe vision loss in spite of treatment. Other treatment options for ocular-related disorders include thermotherapy, radiation therapy, surgery, e.g., macular translocation, removal of excess ocular tissue, drug therapy, and the like. However, in most cases, all available treatment options have limited therapeutic effect, require repeated, costly procedures, and/or are associated with dangerous side-effects.

Given the prevalence of ocular-related disorders, there remains a need for an effective prophylactic and therapeutic treatment of ocular-related disorders. Accordingly, the invention provides materials and methods for achieving a beneficial effect in the eye, such as inhibiting or reducing angiogenesis or preventing photoreceptor cell loss. This and other advantages of the invention will become apparent from the detailed description provided herein.

SUMMARY OF THE INVENTION

The present invention provides a method for treating ocular neovascularization comprising delivering to target cells in the eye of a subject in need of treatment, a vector comprising a promoter sequence in operable linkage with a polynucleotide sequence encoding an anti-angiogenesis gene product, wherein the anti-angiogenesis gene product is expressed in the target cells, thereby treating ocular neovascularization in the subject.

The target cells are preferably retinal cells, more preferably retinal pigment epithelial cells, and the vector is preferably delivered to the target cells via direct sub-retinal injection

The present invention provides for modified soluble vascular endothelial growth factor (VEGF) receptor-1 genes (sFlt1), nucleic acid vectors including the modified genes, optimized viral capsids including the modified genes, and methods of using the modified genes in the treatment of diseases caused ocular neovascularization, such as macular degeneration.

In one aspect, the present invention provides for optimized sFlt1 genes for treating ocular disorder causing neovascularization, such as macular degeneration in a human subject wherein the optimized genes have been modified to increase CG sequences and reduce cis motifs. Preferably the optimized genes comprise sequences SEQ ID NO: 2 or 8.

In yet another aspect, the present invention provides for a method of treating ocular disorder causing neovascularization in a subject, the method comprising:

a. providing at least one recombinant virus vector comprising a nucleotide sequences for comprising a modified sFlt1 gene; and b. administering the recombinant virus vector to the subject under conditions such that said sFlt1 nucleotide sequences are expressed at a level which produces a therapeutically effective amount of sFlt1 (SEQ ID NO: 26) in the subject, wherein a therapeutically effective amount is an amount sufficient to bind with VEGF thereby reducing angiogenesis in retina tissue of the subject.

In a still further aspect, the present invention provides for a method of transducing an immune privilege retina cell with a modified sFlt1 gene, the method comprising contacting the immune privilege retina cell with a recombinant virus vector comprising an optimized sFlt1 gene comprising the sequence of SEQ ID NO: 2 or 8.

Another aspect of the present invention provides for therapies to treat ocular disorder causing neovascularization, such as macular degeneration including gene therapy based on administration of a nucleotide sequence encoding for optimized sFlt1 genes, as recited in SEQ ID NO: 2 or 8.

In an alternative aspect, the present invention provides an expression vector comprising a polynucleotide that encodes an optimized sFlt1 gene or fragment thereof. In one embodiment the expression vector is an AVV virus vector including the sequence of AAV1, AAV2 (SEQ ID NO: 22), AAV3, AAV4, AAV5, AAV6, AAV7, AAV8, AAV 9, AAV10, AAV11, AAV12 or chimeric variants thereof such as variant AAV2 Capsid 2.5 (SEQ ID NO. 10). Other modified sequences nucleotide sequence of modified AAV 1.1 capsid wherein amino acid residue 265 is deleted (SEQ ID NO: 12), nucleotide sequence of modified AAV 6.1 capsid wherein amino acid residue 265 is deleted (SEQ ID NO: 14), nucleotide sequence of modified AAV 6.3.1 capsid wherein amino acid residue 265 is deleted and amino acid residue 531 is changed from a Lys to a Glu (SEQ ID NO: 15). The nucleotide sequence of wildtype AAV 1 capsid is shown in (SEQ ID NO: 11) and the nucleotide sequence of wildtype AAV 6 capsid is set forth in (SEQ ID NO: 13).

In yet another aspect, the present invention provides a recombinant host cell transfected with a polynucleotide that encodes an optimized sFlt1 peptide of the present invention and selected from any one of SEQ ID NOs: 2 to 8.

In a still further aspect, the present invention contemplates a process of preparing a sFlt1 peptide or fragment thereof comprising;

a. transfecting a cell with polynucleotide that encodes the sFlt1 peptide or fragment thereof to produce a transformed host cell; and b. maintaining the transformed host cell under biological conditions sufficient for expression of the peptide.

In another aspect, the present invention relates to the use of an optimized sFlt1 gene of the present invention in the use of a medicament for the treatment of ocular degeneration.

The present invention also provides for a pharmaceutical composition comprising optimized sFlt1 genes for treating ocular disorders causing neovascularization in a human subject wherein the optimized genes have been modified to increase CG sequences and reduce cis motifs and in combination with a pharmaceutically acceptable carrier. The optimized genes comprise a sequence selected from SEQ ID NO: 2 or SEQ ID NO: 8.

Other features and advantages of the invention will be apparent from the following detailed description, drawings and claims.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows the sequences of eight optimized sFlt1 sequences, that being, SEQ ID NO: 1 (sFLT-orf unoptimized), SEQ ID NO: 2 (sFLT-OPT-2 GeneDesign); SEQ ID NO: 3 (sFLT-OPT-3 Genewiz); SEQ ID NO: 4 (sFLT-OPT-4 DNA2.0); SEQ ID NO: 5 (sFLT-OPT-5 Geneart); SEQ ID NO: 6 (sFLT-OPT-6 IDT); SEQ ID NO: 7 (sFLT-OPT-7 BlueHeron); SEQ ID NO: 8 (sFLT-OPT8 Genescript); SEQ ID NO: 9 (concensus)

FIG. 2 shows the increase of GC of the optimized sFlt1 sequences relative to the unoptimized.

FIG. 3 shows the nucleotide sequence of chimeric AAV 2.5 vector (SEQ ID NO: 10).

FIG. 4 shows the nucleotide sequence of wildtype AAV 1 capsid (SEQ ID NO: 11).

FIG. 5 shows the nucleotide sequence of modified AAV 1.1 capsid wherein amino acid residue 265 is deleted (SEQ ID NO: 12).

FIG. 6 shows the nucleotide sequence of wildtype AAV 6 capsid (SEQ ID NO: 13).

FIG. 7 shows the nucleotide sequence of modified AAV 6.1 capsid wherein amino acid residue 265 is deleted (SEQ ID NO: 14).

FIG. 8 shows the nucleotide sequence of modified AAV 6.3.1 capsid wherein amino acid residue 265 is deleted and amino acid residue 531 is changed from a Lys to a Glu (SEQ ID NO: 15).

FIG. 9 shows the sequences of vectors, that being, nucleotides 738 to 1634 of sequenced defined in FIGS. 4 to 8, respectively, SEQ ID NO: 16 (AAV1c wildtype), SEQ ID NO: 17 (AAVc1.1/265 del); SEQ ID NO: 18 (AAV6c wildtype); SEQ ID NO: 19 (AAV6c.1/265del); and SEQ ID NO: 20 (AAV6c.1/265del/K531E) and consensus sequence (SEQ ID NO: 21).

FIG. 10 shows the expression results for sFlt1 for one non-optimized and seven (7) optimized genes by different optimization algorithms and compared to an unoptimized gene sequence (SEQ ID NO: 1 to 8).

FIG. 11 shows the expression results for sFlt1 in a serum medium for three of the optimized genes and a graph showing the concentration of the expressed proteins compared to an unoptimized gene sequence.

FIG. 12 shows the expression results for sFlt1 for two of the optimized genes and a graph showing the concentration of the expressed proteins compared to an unoptimized gene sequence.

FIG. 13 shows photographs of neovascularization of retina tissue when administering the non-optimized gene sequence (SEQ ID NO: 1) and two of the optimized sequences (SEQ ID NO: 2 and 8) included in AAV2 (SEQ ID NO: 22) The control included no sequences for sFlt1 (SEQ ID NO: 23). The graph provides values for the mean area of neovascularization taken from the grouping of testing animals.

FIG. 14 shows photographs and the leakage caused by laser photocoagulation and the increase in leakage in the control (SEQ ID NO: 23) and reduction when included non-optimized sFlt1 (SEQ ID NO: 1) over the testing period.

FIG. 15 shows photographs and the leakage caused by laser photocoagulation and the increase in leakage in the control (SEQ ID NO: 23) and reduction when the vector included optimized sFlt1 (Opt-2) (SEQ ID NO: 24, TR: 20 bp-164 bp, 3518 bp-3662 bp; CBh promoter: 385 bp-1199 bp; sFLT-opt2: 1208 bp-2864 bp; SV40 PolyA: 3281 bp-3431 bp)) over the testing period. Notably when the sFlt1 gene was optimized the reduction in damage or leakage is visible when compared to the results of FIG. 14 using a non-optimized gene.

FIG. 16 shows photographs and the leakage caused by laser photocoagulation and the increase in leakage in the control (SEQ ID NO: 23, (TR: 20 bp-164 bp, 3118 bp-3262 bp; CBh promoter: 385 bp-1199 bp; Luciferase cDNA: 1212 bp-2864 bp; SV40 PolyA: 2881 bp-3031 bp)) and reduction when the vector included optimized sFlt1 (Opt-8) (SEQ ID NO: 25) TR: 20 bp-164 bp, 3518 bp-3662 bp, CBh promoter: 385 bp-1199 bp; sFLT-opt 8: 1208 bp-2864 bp; SV40 PolyA: 3281 bp-3431 bp)) over the testing period. Notably when the sFlt1 gene was optimized the reduction in damage or leakage is visible when compared to the results of FIG. 14 using a non-optimized gene.

FIG. 17 shows the results compiled from FIGS. 14-16 and measured the mean area of CNV when comparing a control (no sFlt1 gene SEQ ID NO: 23) when compared to the non-optimized gene (SEQ ID NO: 1) and Opt-2 (SEQ ID NO: 24) and Opt-8 (SEQ ID NO: 25) optimized genes.

FIG. 18 shows the results when the Opt1 (nonoptimized SEQ ID NO: 1), Opt-2 (SEQ ID NO: 24) and Opt-8 (SEQ ID NO; 25) were diluted 1:10 and administered to the testing animal. The mean area of CNV shows that Opt-2 maintained its effective in reducing CNV when compared to Opt-8 optimized genes and Opt-1 (nonoptimized).

FIG. 19 shows the virus vector construct for the expression of the control Luciferase as shown in SEQ ID NO: 23.

FIG. 20 shows the virus vector construct including the optimized sequence for OPT-2, as shown in SEQ ID NO: 24

FIG. 21 shows the virus vector construct including the optimized sequence for OPT-8, as shown in SEQ ID NO: 25.

DETAILED DESCRIPTION OF THE INVENTION Definitions

Unless otherwise defined, all technical and scientific terms used herein have the meaning commonly understood by one of ordinary skill in the art to which this invention belongs. The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used in the description of the invention and the appended claims, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. The following terms have the meanings given:

“AAV Cap” means AAV Cap proteins, VP1, VP2 and VP3 and analogs thereof.

“AAV Rep” means AAV Rep proteins and analogs thereof.

“AAV TR” means a palindromic sequence, comprising mostly complementary, symmetrically arranged sequences, and includes analogs of native AAV TRs and analogs thereof.

“Biologically-effective” with respect to an amount of a viral vector is an amount that is sufficient to result in infection (or transduction) and expression of the transgene in a target cell.

“Cis-motifs” includes conserved sequences such as found at or close to the termini of the genomic sequence and recognized for initiation of replication; cryptic promoters or sequences at internal positions likely used for transcription initiation or termination.

“Chimeric” means, with respect to a viral capsid or particle, that the capsid or particle includes sequences from different parvoviruses, preferably different AAV serotypes, as described in Rabinowitz et al., U.S. Pat. No. 6,491,907, entitled “Recombinant parvovirus vectors and method of making,” granted on Dec. 10, 2002, the disclosure of which is incorporated in its entirety herein by reference. A particularly preferred chimeric viral capsid is the AAV2.5 capsid, which has the sequence of the AAV2 capsid with the following mutations: 263 Q→A; 265 insertion T; 705 N→A; 708 V→A; and 716 T→N. wherein the nucleotide sequence expressing such capsid is defined as SEQ ID NO: 8.

“Flanked,” with respect to a sequence that is flanked by other elements, indicates the presence of one or more the flanking elements upstream and/or downstream, i.e., 5′ and/or 3′, relative to the sequence. The term “flanked” is not intended to indicate that the sequences are necessarily contiguous. For example, there may be intervening sequences between the nucleic acid encoding the transgene and a flanking element. A sequence (e.g., a transgene) that is “flanked” by two other elements (e.g., TRs), indicates that one element is located 5′ to the sequence and the other is located 3′ to the sequence; however, there may be intervening sequences therebetween.

Polynucleotide” means a sequence of nucleotides connected by phosphodiester linkages. Polynucleotides are presented herein in the direction from the 5′ to the 3′ direction. A polynucleotide of the present invention can be a deoxyribonucleic acid (DNA) molecule or ribonucleic acid (RNA) molecule. Where a polynucleotide is a DNA molecule, that molecule can be a gene or a cDNA molecule. Nucleotide bases are indicated herein by a single letter code: adenine (A), guanine (G), thymine (T), cytosine (C), inosine (I) and uracil (U). A polynucleotide of the present invention can be prepared using standard techniques well known to one of skill in the art.

“Transduction” of a cell by a virus means that there is transfer of DNA or RNA from the virus particle to the cell.

“Transfection” of a cell means that genetic material is introduced into a cell for the purpose of genetically modifying the cell. Transfection can be accomplished by a variety of means known in the art, such as transduction or electroporation.

“Polypeptide” encompasses both peptides and proteins, unless indicated otherwise.

“Transgene” is used in a broad sense to mean any heterologous nucleotide sequence incorporated in a viral vector for expression in a target cell and associated expression control sequences, such as promoters. It is appreciated by those of skill in the art that expression control sequences will be selected based on ability to promote expression of the transgene in the target cell. An example of a transgene is a nucleic acid encoding a therapeutic polypeptide.

“Vector,” means a recombinant plasmid or virus that comprises a polynucleotide to be delivered into a host cell, either in vitro or in vivo.

“Recombinant” means a genetic entity distinct from that generally found in nature. As applied to a polynucleotide or gene, this means that the polynucleotide is the product of various combinations of cloning, restriction and/or ligation steps, and other procedures that result in the production of a construct that is distinct from a polynucleotide found in nature.

“Substantial homology” or “substantial similarity,” means, when referring to a nucleic acid or fragment thereof, indicates that, when optimally aligned with appropriate nucleotide insertions or deletions with another nucleic acid (or its complementary strand), there is nucleotide sequence identity in at least about 95 to 99% of the sequence.

“Recombinant viral vector” means a recombinant polynucleotide vector comprising one or more heterologous sequences (i.e., polynucleotide sequence not of viral origin). In the case of recombinant parvovirus vectors, the recombinant polynucleotide is flanked by at least one, preferably two, inverted terminal repeat sequences (ITRs) that have been known to provide high-level persistent nucleic acid expression.

“Serotype” with respect to vector or virus capsid is defined by a distinct immunological profile based on the capsid protein sequences and capsid structure.

“Peptide”, “polypeptide” and “protein” are used interchangeably to denote a sequence polymer of at least two amino acids covalently linked by an amide bond.

“Homologous” used in reference to peptides, refers to amino acid sequence similarity between two peptides. When an amino acid position in both of the peptides is occupied by identical amino acids, they are homologous at that position. Thus by “substantially homologous” means an amino acid sequence that is largely, but not entirely, homologous, and which retains most or all of the activity as the sequence to which it is homologous. As used herein, “substantially homologous” as used herein means that a sequence is at least 50% identical, and preferably at least 75% and more preferably 95% homology to the reference peptide. Additional peptide sequence modification are included, such as minor variations, deletions, substitutions or derivitizations of the amino acid sequence of the sequences disclosed herein, so long as the peptide has substantially the same activity or function as the unmodified peptides. Derivatives of an amino acid may include but not limited to trifluoroleucine, hexafluoroleucine, 5,5,5-trifluoroisoleucine, 4,4,4-trifluorovaline, p-fluorophenylaline, o-fluorotyrosine, m-fluorotyrosine, 2,3-difluorotyrosine, 4-fluorohistidine, 2-fluorohistidine, 2,4-difluorohistidine, fluoroproline, difluoroproline, 4-hydroxyproline, selenomethionine, telluromethionine, selenocysteine, selenatryptophans, 4-aminotryptophan, 5-aminotryptophan, 5-hydroxytryptophan, 7-azatryptophan, 4-fluorotryptophan, 5-fluorotryptophan, 6-fluorotryptophan, homoallylglycine, homopropargylglycine, 2-butynylglycine, cis-crotylglycine, allylglycine, dehydroleucine, dehydroproline, 2-amino-3-methyl-4-pentenoic acid, azidohomoalanine, asidoalanine, azidonorleucine, p-ethynylphenylalanine, p-azidophenylalanine, p-bromophenylalanine, p-acetylphenylalanine and benzofuranylalanine. Notably, a modified peptide will retain activity or function associated with the unmodified peptide, the modified peptide will generally have an amino acid sequence “substantially homologous” with the amino acid sequence of the unmodified sequence.

The invention provides modified nucleic acids encoding sFlt1. The invention also provides nucleic acid constructs which include as part of their sequence the modified nucleic acid encoding sFlt1. For example, the invention includes plasmids and/or other vectors that include the modified sFlt1 sequence along with other elements, such as regulatory elements. Further, the invention provides packaged gene delivery vehicle, such as a viral capsid, including the modified sFlt1 sequence. The invention also includes methods of expressing sFlt1 by delivering the modified sequence into a cell along with elements required to promote expression in the cell. The invention also provides gene therapy methods in which the modified sFlt1 sequence is administered to a subject, e.g., as a component of a vector and/or packaged as a component of a viral gene delivery vehicle. Treatment may, for example, be effected to reduce angiogenesis in retina tissue. Each of these aspects of the invention is discussed further in the ensuing sections.

Modified Nucleic Acid for Expression of sFlt1

The invention provides a modified sequence encoding sFlt1. The modified sequence includes the native sFlt1 sequence including one or more optimizing modifications. Examples of optimizing modifications include elimination of one or more cis-acting motifs and introduction of one or more Kozak sequences. In one embodiment, one or more cis-acting motifs are eliminated and one or more Kozak sequences are introduced.

Examples of cis acting motifs that may be eliminated include internal TATA-boxes; chi-sites; ribosomal entry sites; AT-rich and/or GC-rich sequence stretches; ARE, INS, and/or CRS sequence elements; repeat sequences and/or RNA secondary structures; (cryptic) splice donor and/or acceptor sites, branch points; and Salt Preferably, GC content is enhanced relative to wild-type sFlt1 and one or more cis-acting motifs are removed. The GC content is preferably at least 20 to 90% greater than the wild type gene. Additionally, the codon adaptation index is preferably >75, >80, >85, >90, or >95.

The modified sFlt1 sequence may also include flanking restriction sites to facilitate subcloning into expression vector.

The invention includes a nucleic acid vector including the modified sFlt1 sequence and various regulatory elements. The precise nature of regulatory elements useful for gene expression will vary from organism to organism. In general, they include a promoter which directs the initiation of RNA transcription in the cell of interest. The promoter may be constitutive or regulated. Constitutive promoters are those which cause an operably linked gene to be expressed essentially at all times. Regulated promoters are those which can be activated or deactivated. Regulated promoters include inducible promoters, which are usually “off” but which may be induced to turn “on,” and “repressible” promoters, which are usually “on” but may be turned “off” Many different regulators are known, including temperature, hormones, cytokines, heavy metals and regulatory proteins. The distinctions are not absolute; a constitutive promoter may often be regulated to some degree. In some cases an endogenous pathway may be utilized to provide regulation of the transgene expression, e.g., using a promoter that is naturally downregulated when the pathological condition improves.

Examples of suitable promoters include adenoviral promoters, such as the adenoviral major late promoter; heterologous promoters, such as the cytomegalovirus (CMV) promoter; the respiratory syncytial virus promoter; the Rous Sarcoma Virus (RSV) promoter; the albumin promoter; inducible promoters, such as the Mouse Mammary Tumor Virus (MMTV) promoter; the metallothionein promoter; heat shock promoters; the α-1-antitrypsin promoter; the hepatitis B surface antigen promoter; the transferrin promoter; the apolipoprotein A-1 promoter; and human sFlt1 promoters. The promoter may be a tissue-specific promoter, such as the mouse albumin promoter, which is active in liver cells as well as the transthyretin promoter (TTR).

Packaged Modified sFlt1 Sequence

The modified sFlt1 sequence may also be provided as a component of a packaged viral vector. In general, packaged viral vectors include a viral vector packaged in a capsid. Viral vectors and viral capsids are discussed in the ensuing sections.

Viral Vector

The viral vector component of the packaged viral vectors produced according to the methods of the invention includes at least one modified sFlt1 sequence and associated expression control sequences for controlling expression of the modified sFlt1 sequence. The viral vector may include cis-acting functions sufficient to enable persistence as episomal forms or by mechanisms including integration of the modified sFlt1 sequence into the genome of a target cell.

In a preferred embodiment, the viral vector includes a portion of a parvovirus genome, such as an AAV genome with rep and cap deleted and replaced by the modified sFlt1 sequence and its associated expression control sequences. The modified sFlt1 sequence is typically inserted adjacent to one or two (i.e., flanked by) AAV TRs or TR elements adequate for viral replication; Xiao et al., J Virol 71; 2: 941-948 (1997), in place of the viral rep and cap ORFs. Other regulatory sequences suitable for use in facilitating tissue-specific expression of the modified sFlt1 sequence in the target cell may also be included.

The viral vector may be any suitable nucleic acid construct, such as a DNA or RNA construct and may be single stranded, double stranded, or duplexed.

Viral Capsid

The viral capsid component of the packaged viral vectors may be a parvovirus capsid. AAV Cap and chimeric capsids are preferred. Examples of suitable parvovirus viral capsid components are capsid components from the family Parvoviridae, such as an autonomous parvovirus or a Dependovirus. For example, the viral capsid may be an AAV capsid (e.g., AAV1, AAV2, AAV3, AAV4, AAV5, AAV6, AAV7, AAV8 AAV 9, AAV10, AAV11 or AAV12 capsid; one skilled in the art would know there are likely other variants not yet identified that perform the same or similar function), or may include components from two or more AAV capsids. A full complement of AAV Cap proteins includes VP1, VP2, and VP3. The ORF comprising nucleotide sequences encoding AAV VP capsid proteins may comprise less than a full complement AAV Cap proteins or the full complement of AAV Cap proteins may be provided.

One or more of the AAV Cap proteins may be a chimeric protein, including amino acid sequences AAV Caps from two or more viruses, preferably two or more AAVs, as described in Rabinowitz et al., U.S. Pat. No. 6,491,907, entitled “Recombinant parvovirus vectors and method of making,” granted on Dec. 10, 2002, the entire disclosure of which is incorporated herein by reference. For example, the chimeric virus capsid can include an AAV1 Cap protein or subunit and at least one AAV2 Cap or subunit. The chimeric capsid can, for example, include an AAV capsid with one or more B19 Cap subunits of human parvovirus, e.g., an AAV Cap protein or subunit can be replaced by a B19 Cap protein or subunit. For example, in a preferred embodiment, the Vp3 subunit of the AAV capsid can be replaced by the Vp2 subunit of B19.

Production of Packaged Viral Vector

The invention includes packaging cells which may be cultured to produce packaged viral vectors of the invention. The packaging cells of the invention generally include cells with heterologous (1) viral vector function(s), (2) packaging function(s), and (3) helper function(s). Each of these component functions is discussed in the ensuing sections.

Viral Vector Functions

The packaging cells of the invention include viral vector functions, along with packaging and vector functions. The viral vector functions typically include a portion of a parvovirus genome, such as an AAV genome, with rep and cap deleted and replaced by the modified sFlt1 sequence and its associated expression control sequences. The viral vector functions include sufficient expression control sequences to result in replication of the viral vector for packaging. Typically, the viral vector includes a portion of a parvovirus genome, such as an AAV genome with rep and cap deleted and replaced by the transgene and its associated expression control sequences. The transgene is typically flanked by two AAV TRs, in place of the deleted viral rep and cap ORFs. Appropriate expression control sequences are included, such as a tissue-specific promoter and other regulatory sequences suitable for use in facilitating tissue-specific expression of the transgene in the target cell. The transgene is typically a nucleic acid sequence that can be expressed to produce a therapeutic polypeptide or a marker polypeptide. The viral vector may be any suitable nucleic acid construct, such as a DNA or RNA construct and may be single stranded, double stranded, or duplexed.

The viral vector functions may suitably be provided as duplexed vector templates, as described in U.S. Patent Publication No. 2004/0029106 to Samulski et al. (the entire disclosure of which is incorporated herein by reference for its teaching regarding duplexed vectors). Duplexed vectors are dimeric self-complementary (sc) polynucleotides (typically, DNA). For example, the DNA of the duplexed vectors can be selected so as to form a double-stranded hairpin structure due to intrastrand base pairing. Both strands of the duplexed DNA vectors may be packaged within a viral capsid. The duplexed vector provides a function comparable to double-stranded DNA virus vectors and can alleviate the need of the target cell to synthesize complementary DNA to the single-stranded genome normally encapsidated by the virus.

The TR(s) (resolvable and non-resolvable) selected for use in the viral vectors are preferably AAV sequences, with serotypes 1, 2, 3, 4, 5 and 6 being preferred. Resolvable AAV TRs need not have a wild-type TR sequence (e.g., a wild-type sequence may be altered by insertion, deletion, truncation or missense mutations), as long as the TR mediates the desired functions, e.g., virus packaging, integration, and/or provirus rescue, and the like. The TRs may be synthetic sequences that function as AAV inverted terminal repeats, such as the “double-D sequence” as described in U.S. Pat. No. 5,478,745 to Samulski et al., the entire disclosure of which is incorporated in its entirety herein by reference. Typically, but not necessarily, the TRs are from the same parvovirus, e.g., both TR sequences are from AAV2

The packaging functions include capsid components. The capsid components are preferably from a parvoviral capsid, such as an AAV capsid or a chimeric AAV capsid function. Examples of suitable parvovirus viral capsid components are capsid components from the family Parvoviridae, such as an autonomous parvovirus or a Dependovirus. For example, the capsid components may be selected from AAV capsids, e.g., AAV1-AAV12 and other novel capsids as yet unidentified or from non human primate sources. Capsid components may include components from two or more AAV capsids, providing a chimeric AAV.

In a more preferred embodiment, one or more of the VP capsid proteins is a chimeric protein, comprising amino acid sequences from two or more viruses, preferably two or more AAVs, as described in Rabinowitz et al., U.S. Pat. No. 6,491,907, entitled “Recombinant parvovirus vectors and method of making,” granted on Dec. 10, 2002, the entire disclosure of which is incorporated in its entirety herein by reference.

For example, the chimeric virus capsid can include a capsid region from an adeno-associated virus (AAV) and at least one capsid region from a B19 virus. The chimeric capsid can, for example, include an AAV capsid with one or more B19 capsid subunits, e.g., an AAV capsid subunit can be replaced by a B19 capsid subunit. For example, in a preferred embodiment, the VP1, VP2 or VP3 subunit of the AAV capsid can be replaced by the VP1, VP2 or VP3 subunit of B19. As another example, the chimeric capsid may include an AAV type 2 capsid in which the type 2 VP1 subunit has been replaced by the VP1 subunit from an AAV type 1, 3, 4, 5, or 6 capsid, preferably a type 3, 4, or 5 capsid. Alternatively, the chimeric parvovirus has an AAV type 2 capsid in which the type 2 VP2 subunit has been replaced by the VP2 subunit from an AAV type 1, 3, 4, 5, or 6 capsid, preferably a type 3, 4, or 5 capsid. Likewise, chimeric parvoviruses in which the VP3 subunit from an AAV type 1, 3, 4, 5 or 6 (more preferably, type 3, 4 or 5) is substituted for the VP3 subunit of an AAV type 2 capsid are preferred. As a further alternative, chimeric parvoviruses in which two of the AAV type 2 subunits are replaced by the subunits from an AAV of a different serotype (e.g., AAV type 1, 3, 4, 5 or 6) are preferred. In exemplary chimeric parvoviruses according to this embodiment, the VP1 and VP2, or VP1 and VP3, or VP2 and VP3 subunits of an AAV type 2 capsid are replaced by the corresponding subunits of an AAV of a different serotype (e.g., AAV type 1, 3, 4, 5 or 6). Likewise, in other preferred embodiments, the chimeric parvovirus has an AAV type 1, 3, 4, 5 or 6 capsid (preferably the type 2, 3 or 5 capsid) in which one or two subunits have been replaced with those from an AAV of a different serotype, as described above for AAV type 2.

The packaged viral vector generally includes the modified sFlt1 sequence and expression control sequences flanked by TR elements sufficient to result in packaging of the vector DNA and subsequent expression of the modified sFlt1 sequence in the transduced cell. The viral vector functions may, for example, be supplied to the cell as a component of a plasmid or an amplicon. The viral vector functions may exist extrachromosomally within the cell line and/or may be integrated into the cells' chromosomal DNA.

Any method of introducing the nucleotide sequence carrying the viral vector functions into a cellular host for replication and packaging may be employed, including but not limited to, electroporation, calcium phosphate precipitation, microinjection, cationic or anionic liposomes, and liposomes in combination with a nuclear localization signal. In embodiments wherein the viral vector functions are provided by transfection using a virus vector; standard methods for producing viral infection may be used.

Packaging Functions

The packaging functions include genes for viral vector replication and packaging. Thus, for example, the packaging functions may include, as needed, functions necessary for viral gene expression, viral vector replication, rescue of the viral vector from the integrated state, viral gene expression, and packaging of the viral vector into a viral particle. The packaging functions may be supplied together or separately to the packaging cell using a genetic construct such as a plasmid or an amplicon. The packaging functions may exist extrachromosomally within the packaging cell, but are preferably integrated into the cell's chromosomal DNA. Examples include genes encoding AAV Rep and Cap proteins.

Helper Functions

The helper functions include helper virus elements needed for establishing active infection of the packaging cell, which is required to initiate packaging of the viral vector. Examples include functions derived from adenovirus, baculovirus and/or herpes virus sufficient to result in packaging of the viral vector. For example, adenovirus helper functions will typically include adenovirus components E1a, E1b, E2a, E4, and VA RNA. The packaging functions may be supplied by infection of the packaging cell with the required virus. The packaging functions may be supplied together or separately to the packaging cell using a genetic construct such as a plasmid or an amplicon. The packaging functions may exist extrachromosomally within the packaging cell, but are preferably integrated into the cell's chromosomal DNA.

Any suitable helper virus functions may be employed. For example, where the packaging cells are insect cells, baculovirus may serve as a helper virus. Herpes virus may also be used as a helper virus in AAV packaging methods. Hybrid herpes viruses encoding the AAV Rep protein(s) may advantageously facilitate for more scalable AAV vector production schemes.

Any method of introducing the nucleotide sequence carrying the helper functions into a cellular host for replication and packaging may be employed, including but not limited to, electroporation, calcium phosphate precipitation, microinjection, cationic or anionic liposomes, and liposomes in combination with a nuclear localization signal. In embodiments wherein the helper functions are provided by transfection using a virus vector or infection using a helper virus; standard methods for producing viral infection may be used.

Packaging Cell

Any suitable permissive or packaging cell known in the art may be employed in the production of the packaged viral vector. Mammalian cells or insect cells are preferred. Examples of cells useful for the production of packaging cells in the practice of the invention include, for example, human cell lines, such as VERO, W138, MRC5, A549, 293 cells, B-50 or any other HeLa cells, HepG2, Saos-2, HuH7, and HT1080 cell lines.

Preferred cell lines for use as packaging cells are insect cell lines. Any insect cell which allows for replication of AAV and which can be maintained in culture can be used in accordance with the present invention. Examples include Spodoptera frugiperda, such as the SD or Sf21 cell lines, Drosophila spp. cell lines, or mosquito cell lines, e.g., Aedes albopictus derived cell lines. A preferred cell line is the Spodoptera frugiperda 519 cell line. The following references are incorporated herein for their teachings concerning use of insect cells for expression of heterologous polypeptides, methods of introducing nucleic acids into such cells, and methods of maintaining such cells in culture: Methods in Molecular Biology, ed. Richard, Humana Press, N J (1995); O'Reilly et al., Baculovirus Expression Vectors: A Laboratory Manual, Oxford Univ. Press (1994); Samulski et al., J. Vir. 63:3822-8 (1989); Kajigaya et al., Proc. Nat'l. Acad. Sci. USA 88: 4646-50 (1991); Ruffing et al., J. Vir. 66:6922-30 (1992); Kimbauer et al., Vir. 219:37-44 (1996); Zhao et al., Vir. 272:382-93 (2000); and Samulski et al., U.S. Pat. No. 6,204,059.

During production, the packaging cells generally include one or more viral vector functions along with helper functions and packaging functions sufficient to result in replication and packaging of the viral vector. These various functions may be supplied together or separately to the packaging cell using a genetic construct such as a plasmid or an amplicon, and they may exist extrachromosomally within the cell line or integrated into the cell's chromosomes.

The cells may be supplied with any one or more of the stated functions already incorporated, e.g., a cell line with one or more vector functions incorporated extrachromosomally or integrated into the cell's chromosomal DNA, a cell line with one or more packaging functions incorporated extrachromosomally or integrated into the cell's chromosomal DNA, or a cell line with helper functions incorporated extrachromosomally or integrated into the cell's chromosomal DNA.

Treatment Methods

The modified sFlt1 gene may be used for gene therapy of ocular neovascularization diseases, such as macular degeneration. An individual may be in need of gene therapy for clinical management of angiogenesis in the retina. Further the present invention may include treatment for visual loss caused by macular edema and evident in subjects with diabetes, uveitis and after cataract surgery.

In particular embodiments, the present invention provides a pharmaceutical composition comprising a vector of the present invention including a modified gene of sFlt1 in a pharmaceutically-acceptable carrier and/or other medicinal agents, pharmaceutical agents, carriers, adjuvants, diluents, etc. For injection, the carrier will typically be a liquid. For other methods of administration, the carrier may be either solid or liquid. For inhalation administration, the carrier will be respirable, and will preferably be in solid or liquid particulate form. As an injection medium, it is preferred to use water that contains the additives usual for injection solutions, such as stabilizing agents, salts or saline, and/or buffers.

Exemplary pharmaceutically acceptable carriers include sterile, pyrogen-free water and sterile, pyrogen-free, phosphate buffered saline. Physiologically-acceptable carriers include pharmaceutically-acceptable carriers. Pharmaceutically acceptable carriers are those which are that is not biologically or otherwise undesirable, i.e., the material may be administered to a subject without causing undesirable biological effects which outweigh the advantageous biological effects of the material.

A pharmaceutical composition may be used, for example, in transfection of a cell ex vivo or in administering a viral vector or cell directly to a subject.

Recombinant virus vectors comprising the modified gene of sFlt1 are preferably administered to the cell in a biologically-effective amount. If the virus vector is administered to a cell in vivo (e.g., the virus is administered to a subject as described below), a biologically-effective amount of the virus vector is an amount that is sufficient to result in transduction and expression of the transgene in a target cell and in an amount to reduce the activity of VEGF.

A further aspect of the invention is a method of treating subjects in vivo with the vector containing modified genes. Administration of the vector to a human subject or an animal in need thereof can be by any means known in the art for administering virus vectors.

Exemplary modes of administration include intravenous, subcutaneous, intradermal, intramuscular, and intraarticular administration, and the like, as well as direct tissue or organ injection, alternatively, intrathecal, direct intramuscular, intraventricular, intravenous, intraperitoneal, intranasal, or intraocular injections. Injectables can be prepared in conventional forms, either as liquid solutions or suspensions, solid forms suitable for solution or suspension in liquid prior to injection, or as emulsions. Alternatively, one may administer the virus in a local rather than systemic manner, for example, in a depot or sustained-release formulation.

Dosages of the inventive virus vector with the modified sFlt1 gene will depend upon the mode of administration, the disease or condition to be treated, the individual subject's condition, the particular viral vector, and the gene to be delivered, and can be determined in a routine manner. Exemplary doses for achieving therapeutic effects are virus titers of at least about 10⁵, 10⁶, 10⁷, 10⁸, 10⁹, 10¹⁰, 10¹¹, 10¹², 10¹³, 10¹⁴, 10¹⁵ transducing units or more, preferably about 10⁸-10¹³ transducing units, yet more preferably 10¹² transducing units.

The modified sFlt1 gene may be administered as components of a DNA molecule having regulatory elements appropriate for expression in the target cells. The modified sFlt1 gene may be administered as components of viral plasmids, such as rAAV vectors. Viral particles may be administered as viral particles alone, whether as an in vivo direct delivery to the portal vasculature or as an ex vivo treatment comprising administering the vector viral particles in vitro to cells from the animal receiving treatment followed by introduction of the transduced cells back into the donor.

Examples

Expression of the Proteins

The novel and unique optimized gene sequences of SEQ ID NOs: 2 to 8 were created by seven different and distinct methods of optimization and were then subsequently expressed. As shown in FIG. 10, the different sequences provided for very different results in three separate assays used to determine the level of protein expression. Using the unoptimized gene sequence as the control for the ELISA/Luc assay, then each optimized gene sequence expressed different amounts of the specific sFlt1 protein. Thus, the optimized sequences are each novel and the clearly it is not known as to which will provide for the optimal amount of the expressed sFlt1 protein.

FIG. 11 provides further indication of the diversity of different optimized gene sequences and the expression thereof wherein SEQ ID NO: 8 (GeneScript) provided the highest concentration of expression. Further, it should be noted that the medium used for expression of the proteins is different from that used in FIG. 10.

Using AAV2 carrying optimized genes vs. wild type sFlt1 coding sequence, side-by-side expression analysis was carried out in vitro (FIG. 12) and ELISA was used to determine the total amount of sFlt1 protein. Based on these studies it is clear that the optimized sFlt1 genes, that being SEQ ID NO: 2 and SEQ ID NO: 8, expressed significantly more sFlt1 protein product when compared to the unoptimized coding sequence when delivered at the same dose.

In Vivo Testing

Notably the mouse retina can be used as a tool to investigate conditions in which normal vascular development becomes unbalanced, leading to sight-threatening diseases, as occurs in human retinopathy of prematurity (ROP). Thus, successful modeling of human ROP in this animal model can replicate the phases of ROP including neovascularization (NV)—along with some of the more frequent complications like vascular leakage. Oxygen-induced retinopathy (OIR) was induced in the testing mice by exposure to increased levels of oxygen for about four days postnatal and then returned to normal oxygen content of about 20%. On P4, three specific vectors were injected into the eyes of the testing mice in an amount of about 0.5 microliters using a sharp needle. Also a control group was included wherein no injection was administered. The vectors included AAV2-sFlt1 unoptimized (SEQ ID NO: 1), AAV2-OPT-2 (SEQ ID NO: 2, GeneDesign) and AAV2-OPT-8 (SEQ ID NO: 8, GeneScript) and a control wherein no sFlt1 was introduced. On P17 the different levels of concentration of expressed sFlt1 were measured by removing the eyes wherein the retina was dissected and cut radially into four quadrants and mounted for examination by fluorescence. The total neovascular area was determined relative to the total retina and then compared to the control.

FIG. 13 shows that using the AAV2-nonoptimized sFlt1 gene (Seq ID NO: 1) showed a mean area of neovascularization of about 0.4 mm² while the control (no sFLT1) was about 1.1 mm². Using the AAV2-Opt-2 vector (SEQ ID NO: 2) it was found that the optimized gene expressed more sFlt1 and this is evident because the mean area of neovascularization was reduced to out 0.1 mm² while the control showed a mean area of neovascularization of about 1.00 mm². Using the vector AAV2-Opt-8 (SEQ ID NO: 8) provided for increased expression of sFlt1 and a mean area of neovascularization of approximately 0.09 mm² with a control of about 0.85 mm². Clearly the optimized genes expressing sFlt1 provided for increased levels of expression causing a surprising and unexpected reduction in the area of neovascularization of retina tissue and intensity of fluorescence.

It was also found that the AAV mediated optimized sFlt1 gene therapy of the present invention reduced and/or prevented laser induced choroidal neovascularization (CNV) in mice. The above described AAV2 vectors, that being AAV2-sFlt1 unoptimized (SEQ ID NO: 1), AVV2-OPT-2 (SEQ ID NO: 2, GeneDesign) and AAV2-OPT-8 (SEQ ID NO: 8, GeneScript) and a control wherein no sFlt1 were introduced by subretinal delivery in an amount of about 0.5 microliters. Two weeks later laser photocoagulation was performed on the mice eyes to create a model for CNV. Seven days after the laser treatment the mice were anesthetized and their pupils were removed. Photographs were taken after the intraperitoneal administration of FITC-GSA-Lectin as a stain. FIGS. 14, 15 and 16 showed that the laser photocoagulation caused leakage in both the controls and the AVV2 vector treated eyes, however leakages was reduced in the AAV2-optimized sFlt1 injected eyes. Importantly in the controls it is evident that the leakage increased while the two optimized treated eyes (FIGS. 15 and 16) showed a reduction of leakage over the period of viewing. AAV-2-Opt-8 showed the greatest reduction in leakage over the period of viewing (1^(st) week, 2^(nd) week and 3^(rd) week), as shown in FIG. 16.

FIG. 17 shows the mean area of CNV for the different groupings of AAV2 vectors (viral vector constructs of FIGS. 20 and 21) compared to the control (viral vector construct of FIG. 19) wherein the testing group includes five mice for each result. Clearly, expression by the AAV2-Opt2 and AAV2-Opt8 genes showed the greatest reduction in area affected by CNV because of a reduced amount of leakage.

The above test was conducted again wherein the solutions, including the AAV2 vectors, were diluted 10 times and testing results regarding leakage and mean area of CNV is shown in FIG. 18. All three vectors showed some inhibition of CNV, however, AAV2-Opt2 still exhibited substantial inhibition effects. 

1-21. (canceled)
 22. An optimized, modified coding sequence for soluble ins-like tyrosine kinase-1 (sFlt1) for treating an ocular disorder associated with neovascularization in retinal cells in a human subject wherein the optimized, modified coding sequence has increased GC content and reduced cis motifs relative to a wild type sFlt1 coding sequence.
 23. The optimized, modified coding sequence of claim 22, that has the nucleotide sequence of SEQ ID SEQ ID NO: 2, SEQ ID NO: 3, SEQ ID NO; 4, SEQ ID NO: 5, SEQ ID NO: 6, SEQ ID NO: 7, SEQ ID NO: 8, or compliment thereof.
 24. A viral vector comprising the optimized, modified coding sequence of claim
 22. 25. The viral vector of claim 24, wherein the viral vector is a recombinant Adeno-Associated Virus (rAAV) vector.
 26. The viral vector of claim 25, wherein the rAAV vector is selected from the group consisting of AAV1, AAV2, AAV3, AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11, AAV12, and combinations thereof.
 27. The viral vector of claim 25, wherein the rAAV vector is a chimera of 2 or more AAV serotypes.
 28. A gene therapy treatment for a subject with an ocular disorder causing neovascularization, said treatment comprising directly administering to an eye of the subject a recombinant adeno-associated viral (rAAV) vector comprising an optimized, modified coding sequence for sFlt-1 operably linked to a promoter sequence to thereby deliver the vector to retinal cells of the subject, wherein the optimized, modified coding sequence has increased GC content and reduced cis motifs relative to a wild type sFlt1 coding sequence, wherein the optimized, modified coding sequence is expressed at a level which produces a therapeutically effective amount of sFlt1 in the retinal cells to thereby treat the subject.
 29. The gene therapy treatment of claim 28, wherein the optimized, modified coding sequence has the nucleotide sequence of SEQ ID SEQ ID NO: 2, SEQ ID NO: 3, SEQ ID NO; 4, SEQ ID NO: 5, SEQ ID NO: 6, SEQ ID NO: 7, SEQ ID NO: 8, or compliment thereof.
 30. The gene therapy treatment of claim 28, wherein the rAAV vector is selected from the group consisting of AAV1, AAV2, AAV3, AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11, AAV12, and combinations thereof.
 31. The gene therapy treatment of claim 28, wherein the rAAV vector is a chimera of 2 or more AAV serotypes.
 32. The gene therapy treatment of claim 28, wherein the optimized, modified sFlt1 coding sequence is flanked by AAV terminal repeats.
 33. A process for expressing a sFlt1 peptide in a retinal cell, the process comprising; directly introducing a recombinant Adeno-Associated Virus (rAAV) vector comprising an optimized, modified coding sequence for sFlt1 operably linked to a promoter sequence into the retinal cell under conditions appropriate for expression of the sFlt1, wherein the optimized, modified coding sequence has increased GC content and reduced cis motifs relative to a wild type sFlt1 coding sequence.
 34. The process of claim 33, wherein the retinal cell is a retinal pigment epithelial cell.
 35. The process of claim 33, wherein the rAAV vector is selected from the group consisting of AAV1, AAV2, AAV3, AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11, AAV12, and combinations thereof.
 36. The process of claim 33, wherein the rAAV vector is a chimera of 2 or more AAV serotypes.
 37. The process of claim 33, wherein the reduced cis motifs are due to an elimination of sequences selected from the group consisting of internal TATA-boxes; chi-sites; ribosomal entry sites; AT-rich sequence stretches; INS sequence elements; CRS sequence elements; repeat sequences; RNA secondary structures; (cryptic) splice donor sites; (cryptic) splice acceptor sites; branch points; and SalI.
 38. A pharmaceutical composition comprising an admixture of: a) a viral vector comprising, in expressible form, an optimized, modified coding sequence for soluble fins-like tyrosine kinase-1 (sFlt1) for treating an ocular disorder associated with neovascularization in retinal cells in a human subject wherein the optimized, modified coding sequence has increased GC content and reduced cis motifs relative to a wild type sFlt1 coding sequence; and b) a pharmaceutically acceptable carrier.
 39. The pharmaceutical composition of claim 38, wherein the viral vector is a recombinant Adeno-Associated Virus (rAAV) viral vector.
 40. The pharmaceutical composition of claim 39, wherein the rAAV vector is selected from the group consisting of AAV1, AAV2, AAV3, AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11, AAV12, and combinations thereof.
 41. The pharmaceutical composition of claim 39, wherein the rAAV vector is a chimera of 2 or more AAV serotypes. 